Maglio Ignacio, Valdez Pascual, Cámera Luis, Finn Bárbara, Klein Manuel, Pincemin Isabel, Ferraro Héctor, Galvalisi Nazareno, Alessandrini Graciana, Manera Jorge, Musacchio Héctor, Contreras Patricia, Garea Mónica, Lüthy Viviana, Nemerovsky Julio, Baldomá Federico, Cherro Ariel, Ranzuglia Leandro, Malfante Pablo, Salvioli Maximiliano, García Analía
Red Bioética para Latinoamérica y El Caribe de UNESCO.
Sociedad Argentina de Medicina (SAM), Buenos Aires, Argentina. E-mail:
Medicina (B Aires). 2020;80 Suppl 3:45-64.
Guidelines on resource allocation, ethics, triage processes with admission and discharge criteria from critical care and palliative care units during the pandemia are here presented. The interdisciplinary and multi-society panel that prepared these guidelines represented by bioethicists and specialists linked to the end of life: clinicians, geriatricians, emergentologists, intensivists, and experts in palliative care and cardiopulmonary resuscitation. The available information indicates that approximately 80% of people with COVID-19 will develop mild symptoms and will not require hospital care, while 15% will require intermediate or general room care, and the remaining 5% will require assistance in intensive care units. The need to think about justice and establish ethical criteria for allocation patients arise in conditions of exceeding available resources, such as outbreaks of diseases and pandemics, with transparency being the main criterion for allocation. These guides recommend general criteria for the allocation of resources relies on bioethical considerations, rooted in Human Rights and based on the value of the dignity of the human person and substantial principles such as solidarity, justice and equity. The guides are recommendations of general scope and their usefulness is to accompany and sustain the technical and scientific decisions made by the different specialists in the care of critically ill patients, but given the dynamic nature of the pandemic, a process of permanent revision and adaptation of recommendations must be ensured.
本文介绍了大流行期间重症监护和姑息治疗单位的资源分配、伦理、分诊流程以及入院和出院标准的指南。编写这些指南的跨学科多社会小组由生物伦理学家和与生命末期相关的专家代表:临床医生、老年病学家、急诊科医生、重症监护医生以及姑息治疗和心肺复苏专家。现有信息表明,约80%的新冠患者将出现轻微症状,无需住院治疗,15%将需要中级或普通病房护理,其余5%将需要重症监护病房的协助。在可用资源超量的情况下,如疾病爆发和大流行时,就需要考虑公平性并制定分配患者的伦理标准,透明度是分配的主要标准。这些指南建议资源分配的一般标准依赖于生物伦理考量,其植根于人权,基于人的尊严价值以及团结、正义和平等的实质性原则。这些指南是具有普遍适用性的建议,其作用是辅助并支持不同专科医生在治疗重症患者时做出的技术和科学决策,但鉴于大流行的动态性质,必须确保对建议进行持续修订和调整的过程。